Kidney Week

Abstract: TH-PO772

Comparative Survival Outcomes of Kidney Transplantation vs. Ongoing Dialysis in Extremely Elderly Patients: A Matched-Pair Study

Session Information

• Transplantation: Clinical - 1
  October 24, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Leeaphorn, Napat, Mayo Clinic Florida, Jacksonville, Florida, United States

Napat Leeaphorn, MD, FASN

• Attieh, Rose Mary, Mayo Clinic Florida, Jacksonville, Florida, United States

Rose Mary Attieh, MD

• Garcia Valencia, Oscar Alejandro, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Oscar Alejandro Garcia Valencia, MD

• Cheungpasitporn, Wisit, Mayo Clinic Minnesota, Rochester, Minnesota, United States

Wisit Cheungpasitporn, MD, FASN

• Jarmi, Tambi, Mayo Clinic Florida, Jacksonville, Florida, United States

Tambi Jarmi, MD, FASN

Background

Limited data exists on the outcomes of kidney transplantation (KT) in extremely elderly patients.

Methods

Using the OPTN database between 2005 and 2019, elderly recipients who were on dialysis before KT were stratified into two groups: 70-74 and ≥75 years old. These recipients were then exactly matched to waitlisted dialysis patients by age at the start of dialysis, race, diabetes status, functional status, and duration on inactive status while on the waitlist (WL). Propensity matching was used for the remaining variables.

Results

Recipients aged 70-74 had a 37% lower risk of death compared with WL candidates of the same age (HR=0.63, p<0.001). This age group benefited from KT regardless of their diabetes status and transplant type. Recipients aged ≥75 had an overall 20% lower risk of death compared with WL candidates (HR=0.80, p=0.001). However, no significant difference in mortality risk was observed in diabetic patients within this age group (HR=0.85, p=0.15). When analyzed by transplant type, there was a trend towards reduced mortality in diabetic living donor KT recipients aged ≥75, though it did not reach statistical significance (HR=0.72, p=0.16). No difference in mortality was found for diabetic deceased donor KT recipients aged ≥75 compared to those on the WL (HR=0.89, p=0.35).

Conclusion

KT provides a significant decrease in mortality risk compared to dialysis among individuals aged 70-74 with ESRD on the WL, as well as non-diabetic patients aged ≥75. However, the advantage of KT becomes less evident in diabetic patients aged ≥75, particularly those without living donors.